完全胸腹腔镜联合Mckeown术治疗食管癌近期结果的回顾性研究

Short-term outcomes of total endoscopy McKeown esophagectomy for esophageal cancer

目的:评价完全胸腹腔镜联合Mckeown食管癌根治术的安全性、可行性和近期疗效。方法:回顾性分析安徽医科大学附属安徽省立医院胸外科2013年10月至2014年4月接受微创Mckeown食管癌根治术的88例患者,其中46例患者施行完全胸腹腔镜联合Mckeown食管癌根治术(total endoscopy Mckeown esophagectomy,TEME),42例施行胸腔镜联合上腹、左颈切口Mckeown食管癌根治术(thoracoscope combined with laparotomy Mckeown esophagectomy,TLME)。比较分析两组患者的临床病理资料、围手术期相关资料及术后并发症发生率。结果:两组患者在性别、年龄、肿瘤部位、术前ASA分级、术前TNM分期及术前合并疾病方面无明显差异。TEME组的腹部出血量和术后疼痛评级均较TLME组患者低(P<0.05),住院总费用稍高于TLME组(P<0.05)。两组患者在肿瘤的组织学类型、术后TNM分期、腹部手术时间、术后重症监护时间、胸引管留置时间、术后住院时间、淋巴结清扫的枚数及站数、淋巴结转移率方面两组无明显差异(P>0.05)。TEME组术后总并发症和呼吸系统并发症发生率低于TLME组(P<0.05)。TEME组的微小并发症中肺炎、心律失常、切口感染发生率较TLME组低(P<0.05),重大并发症中肺炎的发生率低于TLME组(P<0.05)。结论:TEME是安全可行的,近期效果满意。

Objective：To investigate the feasibility, safety, and short-term effect of minimally invasive McKeown esophagecto-my. Methods： We conducted a retrospective evaluation of 88 patients with esophageal carcinoma who received minimally invasive esophagectomy in our center from October 2013 to April 2014. Among the 88 patients, 46 patients underwent total endoscopy McKe-own esophagectomy （TEME） and 42 patients underwent thoracoscope combined with laparotomy Mckeown esophagectomy （TLME）. The clinicopathologic factors, operational factors, and postoperative complications of the two approaches were compared. Results：The two groups were similar in terms of age, sex, American Society of Anesthesiologists grade, tumor location, preoperative staging, and co-morbidity. The TEME approach was associated with a significant decrease in abdominal blood loss and postoperative pain relative to the TEME approach （P〈0.05）. No significant differences were found between the two groups in terms of histologic type, postoperation TNM staging, abdominal operation time, intensive care unit stay, chest tube duration, postoperative stay, the number of total lymph nodes dissected or the stations of the total lymph nodes dissected, and lymph metastasis rate （P〉0.05）. The total morbidity and total re-spiratory complications in the TEME group were lower than those in the TLME group （P〈0.05）. Incidences of pneumonia, arrhythmia, wound infection of minor complications, and pneumonia of major complications were relatively low in the TEME approach. Conclu-sion：Our TEME technique can be safely and effectively performed for cervical anastomosis during esophageal surgeries to achieve fa-vorable early outcomes.